Wu B, Wang J, Zhu J, Zhen Z Z, Lu S Y, Sun F F, Huang J T, Sun X F
State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China.
State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
Zhonghua Xue Ye Xue Za Zhi. 2020 Aug 14;41(8):649-654. doi: 10.3760/cma.j.issn.0253-2727.2020.08.006.
To summarize the efficiency and long-term outcomes of limited-stage Hodgkin lymphoma in children and adolescents with ABVD therapy and determined whether omitting radiotherapy for a low-risk patient enabled the achievement of complete response (CR) after chemotherapy. We retrospectively analyzed data from 13 y (2004-2016) from patients aged ≤18 y with limited-stage HL admitted to the Sun Yat-sen University Cancer Center. Patients received treatment with ABVD chemotherapy alone or ABVD chemotherapy followed by low-dose involved field radiotherapy. Total 85 subjects were eligible for study inclusion; the median age was 12 (3-18) y; 66 (77.6%) were men, 80 (94.1%) had stage-II disease, 56 (65.9%) were at low-risk, and the median follow-up duration was 72 (8-196) months; 12 relapsed, 2 had secondary neoplasm, and 2 died. The 5-year event free survival (EFS) was (85.6±3.8) %, and the overall survival (OS) was 100%. The 5-year EFS and OS was (89.1±4.2) % and 100%, respectively, for the low-risk cohort and (79.3±7.5) % and 100%, respectively for the intermediate-risk cohort. Among the 39 low-risk patients who achieved CR after chemotherapy, 15 received treatment with chemotherapy followed by LD-IFRT. In the exploratory subset analysis, the low-risk cohort who achieved CR after chemotherapy, the 5-year EFS for comparing ABVD alone with chemotherapy followed by LD-IFRT was (87.0±7.0) % versus 100% (=0.506) , and the OS was 100% for both the groups. Our retrospective analysis showed excellent survival of limited-stage HL patients with ABVD therapy. For patients who achieving CR after chemotherapy with low-risk HL, received chemotherapy followed by LD-IFRT does not improve 5-year OS and EFS. The use of risk- and response-based stratification may facilitate the development of effective and less toxic protocols.
总结采用阿霉素、博来霉素、长春花碱和达卡巴嗪（ABVD）方案治疗儿童及青少年局限性霍奇金淋巴瘤的疗效和长期预后，并确定对于低危患者省略放疗能否在化疗后实现完全缓解（CR）。我们回顾性分析了中山大学肿瘤防治中心收治的年龄≤18岁的局限性霍奇金淋巴瘤患者在13年（2004 - 2016年）间的数据。患者接受单纯ABVD化疗或ABVD化疗后行低剂量累及野放疗。共有85名受试者符合研究纳入标准；中位年龄为12（3 - 18）岁；66名（77.6%）为男性，80名（94.1%）为Ⅱ期疾病，56名（65.9%）为低危，中位随访时间为72（8 - 196）个月；12名复发，2名发生二次肿瘤，2名死亡。5年无事件生存率（EFS）为（85.6±3.8）%，总生存率（OS）为100%。低危组的5年EFS和OS分别为（89.1±4.2）%和100%，中危组分别为（79.3±7.5）%和100%。在化疗后达到CR的39名低危患者中，15名接受了化疗后行低剂量累及野放疗（LD - IFRT）的治疗。在探索性子集分析中，化疗后达到CR的低危组中，单纯ABVD治疗与化疗后行LD - IFRT治疗相比，5年EFS分别为（87.0±7.0）%和100%（P = 0.506），两组的OS均为100%。我们的回顾性分析显示，采用ABVD方案治疗的局限性霍奇金淋巴瘤患者生存率良好。对于低危霍奇金淋巴瘤化疗后达到CR的患者，化疗后行LD - IFRT并不能提高5年OS和EFS。基于风险和缓解情况的分层使用可能有助于制定有效且毒性较小的方案。
